Comparative analysis of the results of 3-hour esophageal-gastric-pH monitoring in patients with combined course of gastroesophageal reflux disease and arterial hypertension depending on the available antihypertensive pharmacotherapy

Annotation. Hypotensive drugs, which patients with arterial hypertension take, can have a negative impact on the motility of the esophagus and lower esophageal sphincter, increasing the likelihood of gastroesophageal reflux disease, and worsen it. The aim is to study the features of acid gastroesophageal refluxes and gastric secretory function in patients with combined course of gastroesophageal reflux disease and arterial hypertension, depending on the available anti-hypertensive pharmacotherapy. Patients were divided into four groups, depending on available monotherapy with valsartan, lisinopril, bisoprolol, and amlodipine. Patients were subjected to 3-hour esophageal-gastric-pH monitoring. We conducted a comparative analysis of the following indicators: the number of acid refluxes, the presence of refluxes lasting more than 5 minutes, the average and maximum duration of episodes of reflux. The values of the minimum pH, maximum pH, average pH and median pH in the esophagus, cardiac part of stomach and stomach body were also compared. The results showed that in the group of patients taking valsartan, there was a significant increase in the number of episodes of acid reflux, an increase in the minimum pH in the esophagus, and an increase in % of time with a pH <4 in the esophagus, unlike patients taking lisinopril or amlodipine. There were no differences in gastro-pH monitoring between patients treated with valsartan, lisinopril, bisoprolol, and amlodipine monotherapy. It indicates that increase of gastroesophageal reflux in the valsartan group was not caused by the acid-induced effect of valsartan, but other factors that lead to a decrease and/or disorganization of esophageal motility.

GERD: Clinical Solutions of Problems in General Practice

The objective: To explore the features of acid level and aggravation in stomach and esophagus in patients with isolated GERD, hypertension and their comorbidity. Patients and methods. For this study were selected 4 groups: group of patients with GERD, a group of patients with hypertension, the group of patients with comorbid hypertension and GERD and group without GERD and hypertension (total 78 patients). To all patients were performed 3-channel gastro esophageal pH monitoring. In our case, we conducted a 3-hour version of the survey with standardized provoking breakfast. All patients underwent assessment of gastric secretion by original integrative indicators that reflect basal pH, number of different types of refluxes, duration of alkalization in stomach after meal. Results. GERD patients with hypertension and without are demonstrating an equal number of acid and all (nonacid + acid) reflux which is 18,9 against 19,8 (p>0,05). But the difference between the two groups was that in patients with concomitant hypertension observed longer refluxes 309,3 to 179,1 (p<0,05) and a total acid exposure tends to be prolonged – 25,9 to 20,9 (p>0,05). Our analysis of the state of gastric secretion on the results of 2001 minute intra gastric pH monitoring, showed as expected more intensive acid in both groups of patients with GERD. The most «acidic» patients were GERD patients with hypertension, but compared with similar patients without hypertension, the difference was false due to the relatively small size of the samples. Conclusion. Comorbidity of GERD and hypertension is characterized by severe pathological dysmotility in the lower third of the esophagus, unlike isolated GERD, which affects the increase in acid exposure and susceptibility to long reflux. A factor that may add to burden of GERD in combination with hypertension may be gastric hyperacidity and a clear predisposition to obesity.